River City SAR Member Application Form
Please fill out this form to the best of your abilities. If you have any questions after completing this form, please send an email to info@rivercitysar.org with your NAME and the DATE you submitted your application. All applications are processed within 3-5 business days of receipt. Once your application has been processed by River City SAR personnel, a member of the board will contact you with the next steps of the application process.
Thanks for your interest!
Name
First and last name
Your answer
Mailing Address
Your answer
Phone number
Your answer
Email Address
Your answer
Email Address
Your answer
Which position(s) are you interested in?
Required
Emergency Point of Contact - Name
Your answer
Emergency Point of Contact - Phone Number
Your answer
Why do you want to join our team?
Your answer
Do you have dependable transportation?
Do you have a valid driver's license?
Do you have valid automobile insurance?
Have your driving privileges ever been suspended or revoked?
If yes, select other and state when and why.
Training
Please select any training that you have had, and list others if necessary:
Required
Please list any previous major injuries and/or surgeries that may impact your participation on this team. If none, please write N/A.
The following questions are for history/screening purposes only. This information is kept private and used only in the event of a medical emergency during a response. Command staff are the only personnel with access to this information.
Your answer
Please list any medications taken on a regular basis that may impact your participation or activity on this team. If none, please write N/A.
Your answer
Please list any allergies that may impact your participation on this team. If none, please write N/A.
Your answer
Please list any pre-existing conditions which may impact your participation on this team. If none, please write, N/A.
Your answer
Excluding misdemeanor traffic violations, have you ever been convicted of any misdemeanor or felony offenses?
If you answered yes to the above question, please provide the date, location, jurisdiction, charge, and circumstances surrounding each conviction.
Your answer
Signature
By typing your name, you affirm that the information that you have provided on this application is true and correct to the best of your knowledge. Information provided that is determined to be false is grounds for immediate dismissal from the organization.
Your answer
Submit
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